WSR 99-10-064

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed May 3, 1999, 3:32 p.m. ]

Date of Adoption: May 3, 1999.

Purpose: To implement a federal option as allowed in the Balanced Budget Act (BBA) of 1997 which provides for twelve continuous months of medical benefits for children. It has also been rewritten in order to comply with the principles of Executive Order 97-02.

Citation of Existing Rules Affected by this Order: Amending WAC 388-418-0025.

Statutory Authority for Adoption: RCW 74.04.050 and 74.04.057.

Other Authority: Section 4731 of the BBA (Public Law 105-33).

Adopted under notice filed as WSR 99-07-137 on March 24, 1999.

Changes Other than Editing from Proposed to Adopted Version: Added language in subsections (1) and (4) to clarify the intent of the department concerning when a person's medical program is to be redetermined and when a person is eligible for a medical extension. Eliminated the reference to an obsolete program.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 1, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0. Effective Date of Rule: Thirty-one days after filing.

May 3, 1999

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

2513.10
AMENDATORY SECTION(Amending WSR 98-16-044, filed 7/31/98, effective 9/1/98)

WAC 388-418-0025
Effect of changes on medical program eligibility.

(1) ((Categorically needy (CN) medical and medically needy (MN) medical is continued until a redetermination of)) A client continues to receive Medicaid until the department determines the client’s eligibility ((is made for other)) or ineligibility for another medical ((programs when changes cause a client to become ineligible for)) program. This applies to a client who, during a certification period, becomes ineligible for, is terminated from, or requests termination from:

(a) A Medicaid program or SFA-related medical program; or

(b) Any of the following cash grants:

(i) TANF((/)) or SFA; ((or

(b))) (ii) SSI; ((or

(c))) (iii) GA-H; or

(((d) GA-S; or

(e) CN medical)) (iv) GA-X. See WAC 388-434-0005 for changes reported during eligibility review.

(2) ((When changes cause a refugee cash assistance client to be ineligible,)) A child remains continuously eligible for medical benefits for a period of twelve months from the date of certification for medical benefits or last review, whichever is later. This applies unless the child:

(a) Moves out of state;

(b) Loses contact with the department or the department does not know the child’s whereabouts;

(c) Turns eighteen years of age if receiving children’s health program benefits;

(d) Turns nineteen years of age if receiving children’s CN or CN scope of care program benefits; or

(e) Dies.

(3) When a client becomes ineligible for refugee cash assistance, refugee medical assistance can ((only)) be continued only through the eight-month ((residence)) limit, as described in WAC ((388-400-0030(6))) 388-400-0035(6).

(((3))) (4) A client receiving a TANF((/)) or SFA cash ((recipients are)) grant is eligible for a medical extension, as described under WAC 388-523-0100, when ((termination)) the client’s cash grant is terminated as a result of:

(a) ((Increased employment)) Earned income; or

(b) Collection of((, or increased collection of,)) child or spousal support.

(((4) Clients who report changes in income or resources during a certification period will have their medical continued until eligibility is redetermined for:

(a) CN or medically needy (MN) for TANF/SFA-related, SSI-related, or refugee-related medical; or

(b) Medically indigent (MI) program.))

(5) ((Changes)) A change in income ((reported by clients)) during a certification period ((will not have an affect on medical)) does not affect eligibility for:

(a) ((The)) Pregnant women's medical programs; or

(b) ((The children's CN program; or

(c) The children's health program; or

(d) The first six months of the TANF/SFA-related medical extension; or

(e) The newborn medical program)) The first six months of the TANF/SFA-related medical extension.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090.  98-16-044, 388-418-0025, filed 7/31/98, effective 9/1/98. Formerly WAC 388-508-0840, 388-509-0920, 388-509-0960, 388-522-2205 and 388-522-2210.]

Washington State Code Reviser's Office